Page 597 - Hematology_ Basic Principles and Practice ( PDFDrive )

512 Part V Red Blood Cells

A B C D
Fig. 38.11 This 70-year-old man was being treated with zinc supplementation and was found to have anemia
and neutropenia (hemoglobin, 8.3 g/dL; hematocrit, 23.9%; and white blood cell count, 1200/µL). His
peripheral smear (A) showed a biphasic erythroid population with some small slightly hypochromic cells and
increased anisocytosis (red blood cell distribution width [RDW], 23.9%). The bone marrow aspirate showed
a left shift in granulopoiesis with vacuolization of immature granulocytic and erythroid precursors (B, C). A
Prussian blue–stained aspirate revealed ring sideroblasts (D). The patient’s copper level was less than 0.1 µg/
mL (normal reference range, 0.75–1.45 µg/mL).

may represent mild chronic cases of porphyria or other acquired
Lead Poisoning
abnormalities in heme synthesis. However, evidence for this concept
It has been known for some time that patients suffering from lead is lacking. 263,264
poisoning have an accumulation of protoporphyrin in erythrocytes and
increased urinary excretion of ALA and coproporphyrin. 262 There are
sex-related differences in the porphyrin synthetic response to lead, with SUGGESTED READINGS
females showing a more profound coproporphyrinuria than men. 263 The
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which may explain the absence of photosensitivity. This accumulation associated with a novel ALAS2 mutation and unfortunate skewed
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